Evaluation of a Visual Biofeedback on the Postural Control in Parkinson's Disease

Objectives: Both stabilization and orientation components of postural control are affected in Parkinson's disease (PD). These deficits are partly due to proprioceptive impairments, which frequently coexist with a visual dependence. This study aimed to evaluate if a visual biofeedback - i.e. real time anteroposterior trunk and head orientations indicated with a simplified avatar and represented in a head-mounted display - could improve the postural control of PD patients in response to a postural disturbance. The influence of focusing on one specific component of the postural control (stabilization or orientation) was also examined.

Methods: Seventeen medicated PD patients performed sequences of pull-tests, either with eyes open, eyes closed or visual biofeedback, crossed with the verbal instruction to focus either on the stabilization or on the vertical body orientation. Kinematics data were collected.

Results: Backward trunk tilts consequent to the pulls were unchanged across the different conditions. With eyes open and eyes closed, patients did not recover their initial vertical orientation by adopting a slightly tilted backward position. This bias disappeared with the visual biofeedback. Moreover, falls consecutive to the test were significantly less frequent with the visual biofeedback than in the two other visual conditions. These different orientation and stabilization parameters were not affected by the instruction.

Conclusion: Unlike a verbal instruction, visualizing in real time their own body's geometry improved both components of postural control of PD patients. This provides evidences in PD about links between impaired vertical orientation, deficits in balance control, and contribution of supplementary sensory cues.